Hsc Says No To Cat For Bethlehem Hospital

March 06, 1985|by ANN WLAZELEK, The Morning Call

The Muhlenberg Medical Center of Bethlehem - the only Lehigh Valley hospital without a CAT scanner - should not be permitted to buy the $817,255 scanning unit it has requested, the local health planning agency recommends.

The region has enough CAT scanners to serve the area's needs and an additional unit would "aggravate" the already inflated costs of the diagnostic procedures, concluded Primary Reviewer James Brush of the Health Systems Council of Eastern Pennsylvania in an analysis released yesterday.

Brush recommends a six-month study to determine whether Muhlenberg's projected needs could be served by St. Luke's Hospital, which will soon replace its old CAT scanner with a $1-million unit, before giving Muhlenberg the nod to buy its own equipment.

His analysis also suggested an independent study be done of how CAT scanners are used in the region, since it appears that the cost of the service has nearly doubled (from $3.5-million to $6.2-million) in the past two years.

Muhlenberg's application - which has received a letter of support from Bethlehem Health Director Glen Cooper and a letter questioning the need from Allentown Health Director Gary Gurian - faces reviews this month by HSC's Northampton County sub-area council, project review committee and board of directors. The state health secretary renders the final decision.

Medical Center President Joseph Fitzgerald said his 148-bed institution needs its own equipment because the St. Luke's scanner it shares has experienced an unusual amount of inoperable time, resulting in an almost three-day delay, on average, for the inpatients it transfers.

He also argues that the purchase would enhance competition in the area and allow necessary services for patients too sick to transfer.

In the staff analysis, Brush reports that CAT scanners at Allentown Hospital, Sacred Heart Hospital and Allentown Osteopathic Medical Center are not operating at the minimum number of 3,500 head and body scans required by the regional health plan before an additional scanner can be approved.

The 2.8-day average delay Muhlenberg cites as a major problem in obtaining scans for its inpatients from St. Luke's will be eliminated in May, the report continues, when St. Luke's replaces a 1977 scanner with a 1985 model.

"Down time will be reduced from 17 percent to less than 5 percent and capacity will simultaneously improve by 30 percent," Brush reported.

"All 2,200 projected scans at MMC in 1988 could be done at St. Luke's Hospital without expanding its current operation of 11-hour days, five days a week. Even without the St. Luke's capacity issue, the three Allentown hospitals have more than sufficient capacity to serve every projected MMC patient.

"It is important to note that about half the CAT scans are outpatient where there is relatively easy access in the service area," he continued.

Brush said Muhlenberg Medical Center's average cost per scan, at $189, would be higher than the cost at most facilities in the Lehigh Valley. And, if approved, the additional equipment would reduce procedures performed at other institutions and result in increased costs and charges in those other facilities.

"The best alternative to this project is not to purchase a CAT scanner at this time but determine whether the new scanner at St. Luke's will be able to perform as expected . . . The most important factor of this alternative is that the community willavoid spending $817,000 for equipment that will be duplicative since every patient projected to be served by MMC can be served at other hospitals," Brush concluded.

In regards to the already high cost of CAT scanning in the Valley, the analysis shows that costs in the Allentown-Bethlehem-Easton area increased from $3.5-million in 1983 to $5.4-million, "with all of the additional cost of nearly $2-million occurring in Allentown."

Physicians fees, the analysis notes, usually represents about 40 percent of the combined technical and professional fee. Admitting actual data on physician fees is not readily available, the report adds, "it is clear that physicians have billed more than $1 million more in 1985 than in 1983 for CAT scan services."

The HSC staff recommended approval of a separate application to construct two 10-bed intermediate care facilities for mentally retarded patients in Lehigh and Northampton counties.

The $726,000 project proposed by the Community Foundation for Human Development, Sellersville, addresses the needs of 20 patients facing displacement from Praxis of Easton, which will convert to a nursing home in July.

Noting the proposed $124 cost per day will be higher than the $110 charged by Praxis, but lower than the state hospital cost of more than $125 per diem, HSC's Brush said the project is economically and financially feasible because of state reimbursements, "a reasonable projection of operating costs" and an existing clientele.

Community Foundation received approvals recently to rent six existing five-bed facilities to other Praxis patients. The pending project requires construction for the special needs of those more severely retarded, according to Brush, and therefore represents the least costly alternative to providing the services.